Idiopathic Neonatal Subpial Hemorrhage with Underlying Cerebral Infarct: Imaging Features and Clinical Outcome.

Z Assis,A Kirton,M Sherriff,A Pauranik,X.-C Wei

doi:10.3174/ajnr.a6872

Z Assis, A Kirton + Show 3 more

Open Access

https://doi.org/10.3174/ajnr.a6872

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Abstract

Neonatal subpial hemorrhage with underlying cerebral infarct is a previously described but poorly understood clinicoradiographic syndrome. We sought to further characterize the cranial ultrasound and MR imaging characteristics and associated outcomes of this condition across the full range of gestational ages, including extreme and very preterm neonates. This was a single tertiary pediatric center retrospective case series. Brain MR imaging and cranial ultrasound of neonates with subpial hemorrhage with underlying cerebral infarct were identified from a population-based radiology registry (2006-2020). Original images were reviewed by 2 neuroradiologists blinded to history and outcome. Clinical presentation, course, and outcome at >12 months were abstracted from medical records. The diagnostic utility of cranial ultrasound was compared with that of MR imaging. Sixteen patients were included (median gestational age, 36.5 weeks; range, 27-41 weeks; 31% premature). MR images were obtained acutely at the time of presentation between days 0 and 9 of life. On T2WI and DWI, a consistent presence of a hypointense subpial bleed and an underlying hyperintense cerebral cortex were recognized, which created a distinct MR imaging pattern resembling the yin-yang symbol. Findings of all the MRAs and MRVs were normal. Cranial ultrasound detected 6 of 7 MR imaging lesions with sonographic features correlating well with MR imaging. The 3 extreme or very preterm neonates did not survive. The remainder survived with relatively mild neurologic deficits. Subpial hemorrhage with underlying infarction is a recognizable condition with unique MR imaging and sonographic features. Improved recognition may advance understanding of risk factors and outcomes.

Highlights

BACKGROUND AND PURPOSENeonatal subpial hemorrhage with underlying cerebral infarct is a previously described but poorly understood clinicoradiographic syndrome
Subpial hemorrhage with underlying infarction is a recognizable condition with unique MR imaging and sonographic features
Among the many subtypes of perinatal stroke, there is increasing awareness of neonatal subpial hemorrhage with underlying cerebral infarction diagnosed in the neonatal period.[3]

Summary

Methods

This was a single tertiary pediatric center retrospective case series. Brain MR imaging and cranial ultrasound of neonates with subpial hemorrhage with underlying cerebral infarct were identified from a population-based radiology registry (2006–2020). The participants were retrospectively identified by a pediatric neuroradiologist through a neuroimaging teaching case data base stored on the institutional (Alberta Children's Hospital, Calgary) computer system. Clinical images of the returned subjects were retrospectively reviewed on the clinical PACS, from which subjects who had subpial hemorrhage were included in this study. Image Acquisition MR images of the brain were obtained for clinical reasons on different clinical scanners in 3 different hospitals (Alberta Children's Hospital, Foothills Medical Centre and South Health Campus, all located in Calgary city) in the city from April 2006 to April 2020. The MR imaging and specific scanning parameters varied, but the same essential anatomic sequences used in the current study were always performed, including sagittal and axial T1WI, axial and coronal FSE T2WI, axial DWI (and coronal in some cases), and axial gradient recalledecho (GRE) T2*-weighted imaging. TOF-MRA and noncontrast MRV, including 2D-TOF-MRV and 3D phase-contrast MRV, were performed in most cases (see RESULTS)

Results

Discussion

Conclusion